Individual
LAURA ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1340 BROAD AVE STE 300, GULFPORT, MS 39501-2404
(228) 575-2700
Mailing address
1340 BROAD AVE STE 300, GULFPORT, MS 39501-2404
(228) 575-2700
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
902131
MS
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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